Bautista Jose Antonio L, Lin Chin-Yu, Lu Chi-Ting, Lo Li-Wei, Lin Yenn-Jiang, Chang Shih-Lin, Hu Yu-Feng, Chung Fa-Po, Tuan Ta-Chuan, Chao Tze-Fan, Liao Jo-Nan, Chang Ting-Yung, Kuo Ling, Liu Chih-Min, Liu Shin-Huei, Wu Cheng-I, Kuo Ming-Jen, Li Guan-Yi, Huang Yu-Shan, Wu Shang-Ju, Siow Yoon Kee, Son Ngoc Nguyen Dinh, Tran Dat Cao, Chen Shih-Ann
Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan.
Section of Clinical Cardiac Electrophysiology, Heart Institute, St. Luke's Medical Center - Global City, Taguig City, Philippines.
Front Cardiovasc Med. 2023 Oct 25;10:1265890. doi: 10.3389/fcvm.2023.1265890. eCollection 2023.
Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients.
Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA.
Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHADS-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, = 0.007) and diabetes mellitus (3.1% vs. 22.2%, = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation.
Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.
心房颤动（AF）与二尖瓣反流（MR）存在复杂的相互作用。AF的导管消融（CA）可能是改善AF患者MR严重程度的一种潜在方法。
回顾性纳入2011年至2021年接受导管消融的有症状AF和中重度MR患者。检查患者的基线特征和电生理特征。这些患者在CA后被分为MR改善的第1组和MR难治的第2组。
本研究纳入50例患者（年龄60.2±11.6岁，男性29例）（第1组32例，第2组18例）。与第2组患者相比，第1组患者的CHADS-VASc评分较低（1.7±1.5 vs. 2.7±1.5，P = 0.005），高血压发病率较低（28.1% vs. 66.7%，P = 0.007），糖尿病发病率较低（3.1% vs. 22.2%，P = 0.031）。电解剖三维（3D）标测显示，与第2组患者相比，第1组患者左心房后底部的瘢痕较少（12.5% vs. 66.7%，P < 0.001）。两组之间的AF复发情况无差异。多因素逻辑回归分析后，尽管AF消融成功，但左心房后底部瘢痕独立预测MR难治。
大多数AF合并MR患者在AF消融后MR有所改善。涉及左心房后底部的瘢痕与MR恢复不良有关。
